Provider Demographics
NPI:1801509203
Name:ELAYAN, AMRU OMAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMRU
Middle Name:OMAR
Last Name:ELAYAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5309 LONG BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7948
Mailing Address - Country:US
Mailing Address - Phone:423-794-9088
Mailing Address - Fax:
Practice Address - Street 1:4400 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2644
Practice Address - Country:US
Practice Address - Phone:405-943-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist